MODEL A FORD CLUB OF COLORADO

 

MILESTONE PROGRAM REGISTRATION FORM

 

 

Registrant(s)                                                                                                                        

           

Address                                                                                                                             

 

City, State, Zip                                                                                                                     

 

Phone (Home)                                                     (Cell)                                                      (Work)                                 

 

E-mail                                                            

 

 

It is my understanding that the Milestone Plaque(s) awarded to my car(s) is the property of the Model A Ford Club of Colorado. Should I choose to sell my registered car, or for any reason decide not to renew my membership, it is my responsibility to return the plaque(s) to the Milestone chairperson.

 

Should I fail to return the plaque(s) to the chairperson, I agree to pay the Model A Ford Club of Colorado $25.00 for each missing plaque.

 

 

Signature                                                                                 Date                                        

 

 

MODEL A REGISTRATION

 

Year of Car:                                                               

 

Body Style:                                                             

 

License Plate Number:                                           

 

Current Odometer Reading:                                           

 

 

 

 

Return to:

Fred D. Binkley

3725 W. Grambling Dr.

Denver, CO 80236-2443